Note: Mirazid® is made from an extract of Commiphora Extract Guggul molmol (myrrh) and manufactured by Pharco Pharmaceuticals. It is marketed for treating parasite infections. This bottom line focuses on Commiphora mukul, not Commiphora molmol; however, examples of current research using Mirazid® are included.

Guggul is the common name for the mukul myrrh tree, Commiphora mukul (also known as Commiphora wightii). Guggul also refers to the substance that the tree produces. Guggulipid, a compound that comes from guggul, contains guggulsterone E and guggulsterone Z, which are plant sterols (steroid compounds similar to cholesterol). Before 2003, most evidence suggested that guggulipid reduces total and low-density lipoprotein (LDL or "bad") cholesterol and triglycerides, and increases high-density lipoprotein (HDL or "good") cholesterol. However, results are conflicting. Recent studies report that guggul may benefit high cholesterol. More research is needed.

Guggul has also been studied for acne, weight loss, osteoarthritis, and rheumatoid arthritis. More research is needed in these areas.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Guggulipid supplements have been taken for high cholesterol, although, there is controversy on their effectiveness. Early, low-quality evidence suggests that guggulipid may reduce low-density lipoprotein (LDL or "bad") cholesterol and triglycerides, and increase high-density lipoprotein (HDL or "good") cholesterol. Studies attempting to measure changes in total cholesterol, HDL cholesterol, or triglycerides have found inconsistent results with previous research indicating a lack of effect. More research is needed.

B

Guggulipid has anti-inflammatory effects and has been suggested as a treatment for severe acne. Early research suggests possible short-term improvements in the number of acne lesions. However, further study is needed in this area.

C

Guggulsterone is a plant chemical that has traditionally been used to treat osteoarthritis. It may have anti-inflammatory effects. However, evidence is lacking to support the use of guggul for osteoarthritis. Further study is needed in this area.

C

Evidence is lacking to support the use of guggul alone for the management of rheumatoid arthritis. Further study is needed.

C

Guggul is included in various traditional Ayurvedic formulas used for weight loss. However, evidence is lacking to support guggul's use for this purpose. More research is needed.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

A proven effective dose for guggul in adults is lacking. Guggulipid is thought to be safe in healthy people at normal doses for up to six months.

To treat acne, a dose of guggulipids equal to 25 milligrams of guggulsterone has been taken by mouth twice daily for six weeks, and for up to three months.

To treat high cholesterol, the following doses have been taken by mouth: 25 milligrams of guggulsterone 2-3 times daily for eight weeks; 400-500 milligrams of guggulipid three times daily for 4-12 weeks; 4.5-16 grams of gum guggul daily in single or divided doses for 12-16 weeks; and 500 milligrams of guggul fraction A 2-3 times daily for up to 34 weeks or 1.5 grams daily for 75 weeks.

For weight loss, the following doses have been taken by mouth: 2-4 Medohar® tablets (each containing 250 milligrams of guggul) three times daily for 30 days; 500 milligrams of guggul fraction A three times daily after meals for up to 12 weeks; and 4 grams of gum guggul daily in three divided doses for four weeks.

To treat osteoarthritis, 500 milligrams of guggul (3.5 percent guggulsterones) have been taken by mouth three times daily for three months.

To treat rheumatoid arthritis, 3 grams of guggul have been taken by mouth daily in divided doses for four months.

Children (under 18 years old)

There is no proven safe or effective dose for guggul in children.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with a known allergy or sensitivity to guggul (Commiphora mukul), its parts, or other members of the Burseraceae family.

Side Effects and Warnings

Guggul is likely safe when taken in typical doses for up to six months.

Guggul may affect the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Guggul may lower blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Use cautiously in people with thyroid disorders or those taking thyroid agents. Guggul may affect thyroid function and cause thyroid problems.

Use cautiously in people who have stomach or intestine disorders. Guggul may cause diarrhea, loose stools, nausea, upset stomach, and vomiting.

Use cautiously in people taking cholesterol-lowering agents. Guggul may affect cholesterol levels.

Guggul may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system.

Use cautiously in people taking beta-blockers or calcium channel blockers. Guggul may decrease the effects of these agents.

Use cautiously in people taking red yeast rice, green tea extract, or usnic acid. Guggul may cause liver failure and inflammation when taken with these.

Avoid using large amounts of guggulsterones with estrogens. Guggul may affect estrogen receptors and cause side effects.

Avoid in children, due to a lack of safety information.

Avoid in pregnant or breastfeeding women, or in women who are trying to get pregnant. Guggul may cause abortion.

Avoid in people with a known allergy or sensitivity to guggul (Commiphora mukul), its parts, or other members of the Burseraceae family.

Guggul may affect the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Guggul may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Guggul may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Guggul may affect the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Guggul may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may be altered in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Guggul may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.